25 research outputs found
Abstract A17: Molecular and clinicopathological features of native Nigerian colorectal cancer
No full textAbstract
Colorectal cancer (CRC) needs no introduction in Africa; once a rare cancer type, it is now the 3rd or 4th most common cancer. However, there are significant differences in the incidence rates, tumor biology, and clinical behavior in comparison to other populations. While the total incidence rates are about one-tenth of those in the developed world, Nigerian CRC occurs at a younger age and rapidly metastasizes. Molecular pathology and genetics of African CRC have not been comprehensively studied. In addition to better understanding of the biology of African CRC, analysis of genetic and molecular biomarkers, including microsatellite instability (MSI), is aimed at improving CRC diagnosis, treatment, and prognosis in Africa. We obtained 83 CRC paraffin-embedded blocks from the University of Ibadan and private pathology laboratories in Ibadan collected in the period from 2007 to 2014. Median age of the cases was 56±14.6 years with equal number of males and females. More than 60% of the patients had stage III and IV CRC. The majority were adenocarcinomas (76%) with a relatively high prevalence of mucinous adenocarcinoma (10%) and signet ring carcinoma (4%). Of all patients, 66% had rectal cancer. Poorly differentiated tumors were observed in 34% of all cases. We found a high prevalence of MSI CRC (43%, 15/35) in the tested Nigerian samples. There were no significant differences in clinicopathological features, including tumor location, between MSI and microsatellite stable (MSS) CRC. Our results are in line with our previous report that found a high prevalence (41%) of MSI CRC in Ghanaian patients. These findings raise important questions about the role of genetic and environmental factors in CRC development in West Africa.
Citation Format: David O. Irabor, Marilena Melas, Stephen B. Gruber, Chanjuan Shi, Leon Raskin. Molecular and clinicopathological features of native Nigerian colorectal cancer [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A17.</jats:p
LOCAL ATTITUDES, MORAL OBLIGATION, CUSTOMARY OBEDIENCE AND OTHER CULTURAL PRACTICES: THEIR INFLUENCE ON THE PROCESS OF GAINING INFORMED CONSENT FOR SURGERY IN A TERTIARY INSTITUTION IN A DEVELOPING COUNTRY
No full textThe process of obtaining informed consent in a teaching hospital in a developing country (e.g. Nigeria) is shaped by factors which, to the Western world, may be seen to be anti-autonomous: autonomy being one of the pillars of an ideal informed consent. However, the mix of cultural bioethics and local moral obligation in the face of communal tradition ensures a mutually acceptable informed consent process. Paternalism is indeed encouraged by the patients who prefer to see the doctor as all-powerful and all-knowing, and this is buttressed by the cultural practice of customary obedience to those 'above you': either in age or social rank. The local moral obligation reassures the patients that those in authority will always look after others placed in their care without recourse to lengthy discussions or signed documentation, while the communal traditions ensure that the designated head of a family unit has the honor and sole responsibility of assenting and consenting to an operation to be carried out on a younger, or female, member of the family. Indeed it is to only a few educated patients that the informed consent process is deemed a shield against litigation by the doctors. This paper later addresses the need for physicians to update their knowledge on the process of informed consent through the attendance of biomedical ethics courses, which should highlight socio-cultural practices that may make this process different from the Western concept, but perfectly acceptable in this setting
Perfiles de caída de la bilirrubina sérica luego de corrección quirúrgica de la ictericia obstructiva
No full textThis is the beginning of a prospective study on patients who have obstructive jaundice to see how the serum bilirubin falls after operative relief of the obstruction. Seven of such patients have been studied; four had carcinoma of the head of the pancreas while the other three had choledocholithiasis. The patients with carcinoma had relief of the jaundice through a biliary-enteric anastomosis and those with common bile duct stones had choledochotomy with stone extraction which was completed with insertion of a T-tube. Serial bilirubin estimations were then performed post-operatively to chart the pattern and rate of descent of this in each patient. Our observations suggest that the pattern of fall of serum bilirubin after successful decompression of the extra-hepatic biliary tree exhibit a distinct pattern regardless of the surgical procedure performed for the relief of the obstruction.El presente artículo es el reporte preliminar de un estudio prospectivo de pacientes con ictericia obstructiva, que evalúa la disminución progresiva en los niveles séricos de bilirrubina luego de la corrección quirúrgica de la obstrucción. El estudio incluye 7 pacientes, 4 de ellos con carcinoma en la cabeza del páncreas y los 3 restantes cursaron con coledocolitiasis. Los pacientes con carcinoma fueron sometidos a una anastomosis bilio-entérica con el fin de corregir la ictericia, mientras que los pacientes con cálculos en el conducto biliar fueron sometidos a coledocotomía, extracción de los cálculos biliares e inserción de un tubo en T. Posteriormente, se realizaron numerosas cuantificaciones de los niveles de bilirrubina en suero, para determinar el patrón y la taza de descenso de dichos niveles en cada paciente. Los resultados muestran el patrón de caída de los niveles séricos de bilirrubina luego de la desobstrucción exitosa de las vías biliares extrahepáticas. Tres pacientes mostraron un patrón aberrante a pesar del correcto procedimiento quirúrgico
Perfiles de caída de la bilirrubina sérica luego de corrección quirúrgica de la ictericia obstructiva
No full textThis is the beginning of a prospective study on patients who have obstructive jaundice to see how the serum bilirubin falls after operative relief of the obstruction. Seven of such patients have been studied; four had carcinoma of the head of the pancreas while the other three had choledocholithiasis. The patients with carcinoma had relief of the jaundice through a biliary-enteric anastomosis and those with common bile duct stones had choledochotomy with stone extraction which was completed with insertion of a T-tube. Serial bilirubin estimations were then performed post-operatively to chart the pattern and rate of descent of this in each patient. Our observations suggest that the pattern of fall of serum bilirubin after successful decompression of the extra-hepatic biliary tree exhibit a distinct pattern regardless of the surgical procedure performed for the relief of the obstruction.El presente artículo es el reporte preliminar de un estudio prospectivo de pacientes con ictericia obstructiva, que evalúa la disminución progresiva en los niveles séricos de bilirrubina luego de la corrección quirúrgica de la obstrucción. El estudio incluye 7 pacientes, 4 de ellos con carcinoma en la cabeza del páncreas y los 3 restantes cursaron con coledocolitiasis. Los pacientes con carcinoma fueron sometidos a una anastomosis bilio-entérica con el fin de corregir la ictericia, mientras que los pacientes con cálculos en el conducto biliar fueron sometidos a coledocotomía, extracción de los cálculos biliares e inserción de un tubo en T. Posteriormente, se realizaron numerosas cuantificaciones de los niveles de bilirrubina en suero, para determinar el patrón y la taza de descenso de dichos niveles en cada paciente. Los resultados muestran el patrón de caída de los niveles séricos de bilirrubina luego de la desobstrucción exitosa de las vías biliares extrahepáticas. Tres pacientes mostraron un patrón aberrante a pesar del correcto procedimiento quirúrgico
Perfiles de caída de la bilirrubina sérica luego de corrección quirúrgica de la ictericia obstructiva
No full textThis is the beginning of a prospective study on patients who have obstructive jaundice to see how the serum bilirubin falls after operative relief of the obstruction. Seven of such patients have been studied; four had carcinoma of the head of the pancreas while the other three had choledocholithiasis. The patients with carcinoma had relief of the jaundice through a biliary-enteric anastomosis and those with common bile duct stones had choledochotomy with stone extraction which was completed with insertion of a T-tube. Serial bilirubin estimations were then performed post-operatively to chart the pattern and rate of descent of this in each patient. Our observations suggest that the pattern of fall of serum bilirubin after successful decompression of the extra-hepatic biliary tree exhibit a distinct pattern regardless of the surgical procedure performed for the relief of the obstruction.El presente artículo es el reporte preliminar de un estudio prospectivo de pacientes con ictericia obstructiva, que evalúa la disminución progresiva en los niveles séricos de bilirrubina luego de la corrección quirúrgica de la obstrucción. El estudio incluye 7 pacientes, 4 de ellos con carcinoma en la cabeza del páncreas y los 3 restantes cursaron con coledocolitiasis. Los pacientes con carcinoma fueron sometidos a una anastomosis bilio-entérica con el fin de corregir la ictericia, mientras que los pacientes con cálculos en el conducto biliar fueron sometidos a coledocotomía, extracción de los cálculos biliares e inserción de un tubo en T. Posteriormente, se realizaron numerosas cuantificaciones de los niveles de bilirrubina en suero, para determinar el patrón y la taza de descenso de dichos niveles en cada paciente. Los resultados muestran el patrón de caída de los niveles séricos de bilirrubina luego de la desobstrucción exitosa de las vías biliares extrahepáticas. Tres pacientes mostraron un patrón aberrante a pesar del correcto procedimiento quirúrgico
Perfiles de caída de la bilirrubina sérica luego de corrección quirúrgica de la ictericia obstructiva
No full textThis is the beginning of a prospective study on patients who have obstructive jaundice to see how the serum bilirubin falls after operative relief of the obstruction. Seven of such patients have been studied; four had carcinoma of the head of the pancreas while the other three had choledocholithiasis. The patients with carcinoma had relief of the jaundice through a biliary-enteric anastomosis and those with common bile duct stones had choledochotomy with stone extraction which was completed with insertion of a T-tube. Serial bilirubin estimations were then performed post-operatively to chart the pattern and rate of descent of this in each patient. Our observations suggest that the pattern of fall of serum bilirubin after successful decompression of the extra-hepatic biliary tree exhibit a distinct pattern regardless of the surgical procedure performed for the relief of the obstruction.El presente artículo es el reporte preliminar de un estudio prospectivo de pacientes con ictericia obstructiva, que evalúa la disminución progresiva en los niveles séricos de bilirrubina luego de la corrección quirúrgica de la obstrucción. El estudio incluye 7 pacientes, 4 de ellos con carcinoma en la cabeza del páncreas y los 3 restantes cursaron con coledocolitiasis. Los pacientes con carcinoma fueron sometidos a una anastomosis bilio-entérica con el fin de corregir la ictericia, mientras que los pacientes con cálculos en el conducto biliar fueron sometidos a coledocotomía, extracción de los cálculos biliares e inserción de un tubo en T. Posteriormente, se realizaron numerosas cuantificaciones de los niveles de bilirrubina en suero, para determinar el patrón y la taza de descenso de dichos niveles en cada paciente. Los resultados muestran el patrón de caída de los niveles séricos de bilirrubina luego de la desobstrucción exitosa de las vías biliares extrahepáticas. Tres pacientes mostraron un patrón aberrante a pesar del correcto procedimiento quirúrgico
Investors’ attention: does it impact the Nigerian stock market activities?
No full textPurpose: The author investigates whether investors’ online information demand measured by Google search query and the changes in the numbers of Wikipedia page view can explain and predict stock return, trading volume and volatility dynamics of companies listed on the Nigerian Stock Exchange. Design/methodology/approach: The multiple regression model which encompasses both the univariate and multivariate regression framework was employed as the research methodology. As part of our pre-analysis, we test for multicollinearity and applied the Wu/Hausman specification test to detect whether endogeneity exist in the regression model. Findings: We provide novel and robust evidence that Google searches neither explain the contemporaneous nor predict stock return, trading volume and volatility dynamics. Similarly, results also indicate that trading volume and volatility dynamics have no relationship with changes in the numbers of Wikipedia pages view related to stock activities. Originality/value: This study opens new strand of empirical literature of “investors' attention” in the context of African stock markets as empirical evidence. No evidence from previous studies on investors' attention exist, whether in Google search query or Wikipedia page view, with respect to African stock markets, particularly the Nigerian stock market. This study seeks to bridge these knowledge gaps by examining these relations
Pyoderma gangrenosum and ulcerative colitis in the tropics Pioderma gangrenoso e colite ulcerativa nos trópicos
No full textPyoderma gangrenosum is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration. There may be rapidly enlarging, painful ulcers with undermined edges and a necrotic, hemorrhagic base. Disorders classically associated with pyoderma gangrenosum include rheumatoid arthritis, inflammatory bowel disease, paraproteinemia and myeloproliferative disorders. There have been some reports of the occurrence of pyoderma gangrenosum in Africa, and in Nigeria, but only one specifically reported pyoderma gangrenosum in association with ulcerative colitis. We report on a 45-year-old man who presented with pyoderma gangrenosum associated with ulcerative colitis; the second report in Nigeria. The skin lesions were managed with daily honey wound dressings. Oral dapsone and prednisolone were started. The frequency of the bloody diarrhea decreased, and was completely resolved by the second week after admission. The ulcers also showed accelerated healing. The goal of therapy is directed towards the associated systemic disorder, if present.Pioderma gangrenoso é uma rara forma de inflamação dermatológica, caracterizada por ulceração progressiva e recorrente da pele. Pode ocorrer rápida formação de úlceras dolorosas expansivas, com bordas solapadas e base necrótica e hemorrágica. Condições classicamente associadas com pioderma gangrenoso incluem artrite reumatóide, doença inflamatória intestinal, paraproteinemia e doenças mieloproliferativas. Existem alguns relatos da ocorrência de pioderma gangrenoso na África e na Nigéria, mas apenas um relato específico da associação de pioderma gangrenoso e colite ulcerativa. Os autores relatam o caso de um homem de 45 anos que apresentou pioderma gangrenoso associado a colite ulcerativa, sendo este o segundo relato na Nigéria. As lesões de pele foram tratadas com curativos diários de mel. Foram utilizadas dapsona e prednisona via oral. A freqüência de diarréia sanguinolenta diminuiu e se resolveu completamente até a segunda semana após a admissão. As úlceras também mostraram rápida cicatrização. A meta do tratamento deve abordar também a doença sistêmica associada, quando presente
Abstract B07: Molecular characterization of colorectal cancer in West Africans
No full textAbstract
Introduction: To reduce global disparities in cancer outcomes, there is a need for more concerted efforts to develop the capacity of health care providers to appropriately diagnose and treat common cancers. Colorectal cancer (CRC) incidence in indigenous Africans is significantly lower than in Caucasians but there is a paucity of data on the genetic determinants and molecular biology of colorectal cancer in Nigerians. Lynch syndrome (LS), defined by germ-line mutation in one of the DNA mismatch repair (MMR) genes (MLH1, MSH2, MSH6, PMS2), is the most common heritable syndrome predisposing to CRC. Loss of MMR proteins can be readily detected by immunohistochemistry (IHC) in both Lynch syndrome and sporadic CRC, and further testing for mutated BRAF protein is helpful in distinguishing Lynch syndrome from sporadic CRC.
Materials and Methods: With IRB approval and under a collaborative arrangement with the University of Chicago, seven tissue microarray (TMA) blocks were constructed from CRC samples obtained from the University College Hospital in Ibadan, Federal Teaching Hospital in Gombe, Olabisi Onabanjo University in Sagamu and Ahmadu Bello University in Zaria. TMAs included duplicate 1.0-mm cores of CRC tissue and adjacent normal. For the four MMR proteins, IHC was performed on these TMAs with the following antibodies: MLH1 (Thermo Scientific Pierce Biotech), MSH2 (Life Technologies), MSH6 (Novex), PMS2 (Pierce), anti-BRAF V600E (Roche). All IHC-stained slides (MLH1, MSH2, MSH6, PMS2) were evaluated for expression levels of those proteins in the tumor tissue relative to normal tissue (control) using the following scoring criteria: normal expression was defined as nuclear staining within tumor cells, negative protein expression was defined as complete absence of nuclear staining within tumor cells, and cases with immunoreactivity in 0-10% of tumor cells were scored as equivocal. The slides stained with anti-BRAF V600E (VE1) were scored on a scale of 0 to 3. Strong cytoplasmic staining was scored as 3, medium as 2, 1 as weak, and 0 when the staining was absent.
Results: Of the total evaluable CRC cases, 152 of 293 (52%) were males aged between 16 and 90 years, mean age of 47.33 +/-17.57, while there were 141 female cases, with a mean age of 49.71+/-14.75. More than a quarter of the cases were under 40 years of age. By our IHC screening algorithm, 140 (48%) of the patients had intact MMR proteins, while 153 (52%) patients had at least one MMR protein absent. The most common proteins lost were MLH1/ PMS2 (141 cases, 48.13% of total) cases, followed by the loss of MSH2/MSH6 (12 cases, 4.10% of total). Testing of the group in which MLH1/ PMS2 proteins were absent (141 patients) showed mutated BRAF in only 31 cases (22% of this group). The cases which lack MLH1/ PMS2 and are negative for the BRAF mutation (110 cases), as well as those which are MSH2/MSH6 negative (12 cases), form a group of 122 cases (41.64% of total) which would need additional tests for hypermethylation and referral for genetic counseling.
Conclusion: In this dataset of relatively young onset CRC cases, a large percentage of cases are of the HNPCC subtype. Use of IHC as a universal screening test for all CRC cases, as well as follow-up referral for genetic counseling, could be an innovative approach to CRC cancer control in the population.
Citation Format: Aliyu Lawan, Galina Khramtsova, David Irabor, Mustapha Ajani, Lise Sveen, Yusuf M. Abdullah, Henry O. Ebili, Umar Saad, John O. Ogunbiyi, Olufunmilayo I. Olopade, Abideen O. Oluwasola. Molecular characterization of colorectal cancer in West Africans. [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer: From Initiation to Outcomes; 2016 Sep 17-20; Tampa, FL. Philadelphia (PA): AACR; Cancer Res 2017;77(3 Suppl):Abstract nr B07.</jats:p
